As the famous F. Scott Fitzgerald line goes, the rich are different from you and me — and apparently so, too, are their face-lifts.

Just ask Hilda Back, 63, who traveled from her home in Woodlands, Texas, to New York and shelled out $230,000 for a nip and tuck at the hands of Dr. Andrew Jacono, a plastic surgeon who is perhaps best known for doing the designer Marc Jacobs’s recent face-lift. Ms. Back said the cost for her surgery, which included a brow-lift, upper and lower eyes, face-lift, lip-lift, neck-lift, earlobe reconstruction and rhinoplasty, was “a little higher than what I expected,” but she is happy with her results.

“I have a Rolls-Royce, I have three homes, I have everything I could possibly want, but I was still depressed,” Ms. Back said. “The way I look at this is: This is my face, and it’s going everywhere I go.”

So, then, why not the $200,000 face-lift? Just as the prices of luxury real estate, art, cars and other collectibles have skyrocketed in recent years, so has the cost of a nip and tuck at the hands of an elite group of savvily marketed plastic surgeons, most of whom specialize in face-lifts and have monthslong waiting lists, despite their fees.

“It’s a little like the label on clothes, or if the price of the wine is more, it’s better,” said Dr. Jonathan Sykes, a plastic surgeon in Beverly Hills and Sacramento and a past president of the American Academy of Facial Plastic and Reconstructive Surgery. “Is facial surgery worth the super-high tariff? Only the consumer can decide that.” (Dr. Sykes’s face-lifts cost $40,000 to $50,000, he said.)

While inflationary pressures, including the cost of medical supplies and support-staff salaries, and a jump in demand — what the industry has christened the “Zoom boom” — have led many doctors to raise their rates, the average cost of a face-lift in the United States has increased only marginally to $9,127 in 2021, up 3 percent since 2020, according to the Aesthetic Society, an association of board-certified plastic surgeons.

The doctors touting their “designer” face-lifts insist that their advanced technique, elevated aesthetic sensibilities and experience allow them to charge these rates. Dr. Lara Devgan, a plastic surgeon in Manhattan, likened what she does to “commissioning an artist to make a very beautiful painting for you.” Dr. Devgan charges up to $200,000 for a face-lift.

“At first blush, it may seem like a big number, but I think of this as a question of value, not of cost,” Dr. Devgan said. “Your face is your job, it’s your love life, it’s your identity.”

Dr. Julius Few, a plastic surgeon in Chicago and Los Angeles, charges $50,000 for a “basic face-lift,” he said, and “well into the six figures” for more extensive procedures. In an interview, he spoke about his love of painting and photography and 22 years of focusing on faces.

“For the affluent patient I treat, this is really more like purchasing artwork than purchasing a technical procedure,” said Dr. Jacono, who helped pioneer a technique that’s referred to as an “extended deep plane” face-lift, which he has taught to other doctors around the world.

The key difference between a deep plane face-lift and the SMAS (which stands for superficial musculoaponeurotic system and refers to the layer of tissue and fascia between the skin and the muscles of the face) is that the deep-plane lift allows the skin and SMAS to stay attached, preserving capillaries and blood flow to the skin, while the SMAS technique separates them. The deep-plane lift works by repositioning the facial ligaments that stretch with age and gravity, allowing for movement of the face so that it doesn’t look pulled, as was often the result of face-lifts of yore.

Many surgeons perform deep-plane face-lifts and don’t ask their patients to drop close to a quarter-million dollars on the surgery. “I understand it is a luxury item, and it does have tremendous value, but it shouldn’t be just for the 1 percent,” said Dr. Matthew White, a plastic surgeon in Manhattan who does extended deep-plane face-lifts.

Dr. White said that the procedure should be at a premium because it does require a lot of skill but that, morally and ethically, a wider range of patients should have access to such work.

For the very well-heeled — and such sentiments notwithstanding — the idea of dropping the equivalent of four years of college tuition on elective surgery barely raises an eyebrow.

Dr. Steven Levine, a plastic surgeon in Manhattan, recalled a follow-up visit with a patient who was about to have a fitting for a dress that she was going to wear to the Met gala and that she said cost $425,000. “I thought, ‘You got a great deal on this face-lift,’” said Dr. Levine, who charges $50,000 to $110,000 for a face, brow and neck lift, plus lower and upper eyelids.

So, assuming it’s in the budget, what exactly does $200,000 buy?

Surgery is priced depending on several factors, including how complicated it is and how many areas of the face are treated. A face-lift can include a brow lift, lower and upper eyelid surgery, rhinoplasty, lip lifts, mid-face lifts, neck lifts and a host of other add-ons — fat grafting, facial implants, buccal fat par removal and skin lasers — all of which add thousands to the final bill.

Then there is the postoperative care, which can include 24/7 direct access to your surgeon and at-home nurses. Dr. Chia Chi Kao, a plastic surgeon in Beverly Hills who is known for his scar-free endoscopic “ponytail face-lift,” meaning that incisions are made behind the hairline, runs an outpatient surgery and aftercare center with suites where patients can recover with the help of a hyperbaric oxygen chamber.

“It’s like a luxury hotel,” said Lily Bell, 48, a beauty industry executive in Beverly Hills, who stayed five days and four nights in Dr. Kao’s center and spent $212,000 on her face- and neck-lift and recovery.

Diane Pizzoli, 68, a fashion designer in Roseland, N.J., had several face-lift consultations with doctors, some of whom presented her with estimates that were close to six figures, before choosing Dr. White to do her surgery this winter.

“Some of these other doctors were really self-promoting and bragging about celebrities they’ve done,” said Ms. Pizzoli, who ultimately spent $50,000 on her face-lift and neck-lift and eyelid surgery and recovery.

“I still look like myself, just much younger,” she said. “A higher fee is not always co-measured with a successful result.”

Image Credit: Vanessa Saba | The New York Times, May 3, 2022